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PubMed2002

Economic evaluation of the benefits of reducing acute cardiorespiratory morbidity associated with air pollution.

BACKGROUND: Few assessments of the costs and benefits of reducing acute cardiorespiratory morbidity related to air pollution have employed a comprehensive, explicit approach to capturing the full societal value of reduced morbidity. METHODS: We used empirical data on the duration and severity of episodes of cardiorespiratory disease as inputs to complementary models of cost of treatment, lost productivity, and willingness to pay to avoid acute cardiorespiratory morbidity outcomes linked to air pollution in epidemiological studies. A Monte Carlo estimation procedure was utilized to propagate uncertainty in key inputs and model parameters. RESULTS: Valuation estimates ranged from 13 dollars (1997, Canadian) (95% confidence interval, 0-28 dollars) for avoidance of an acute respiratory symptom day to 5,200 dollars (4,000 dollars-6,400 dollars) for avoidance of a cardiac hospital admission. Cost of treatment accounted for the majority of the overall value of cardiac and respiratory hospital admissions as well as cardiac emergency department visits, while lost productivity generally represented a small proportion of overall value. Valuation estimates for days of restricted activity, asthma symptoms and acute respiratory symptoms were sensitive to alternative assumptions about level of activity restriction. As an example of the application of these values, we estimated that the observed decrease in particulate sulfate concentrations in Toronto between 1984 and 1999 resulted in annual benefits of 1.4 million dollars (95% confidence interval 0.91-1.8 million dollars) in relation to reduced emergency department visits and hospital admissions for cardiorespiratory disease. CONCLUSION: Our approach to estimating the value of avoiding a range of acute morbidity effects of air pollution addresses a number of limitations of the current literature, and is applicable to future assessments of the benefits of improving air quality.

Air Pollutants↗
PubMed2005

Lymphoscintigraphy and triangulated body marking for morbidity reduction during sentinel node biopsy in breast cancer.

Current trends in patient care include the desire for minimizing invasiveness of procedures and interventions. This aim is reflected in the increasing utilization of sentinel lymph node biopsy, which results in a lower level of morbidity in breast cancer staging, in comparison to extensive conventional axillary dissection. Optimized lymphoscintigraphy with triangulated body marking is a clinical option that can further reduce morbidity, more than when a hand held gamma probe alone is utilized. Unfortunately it is often either overlooked or not fully understood, and thus not utilized. This results in the unnecessary loss of an opportunity to further reduce morbidity. Optimized lymphoscintigraphy and triangulated body marking provides a detailed 3 dimensional map of the number and location of the sentinel nodes, available before the first incision is made. The number, location, relevance based on time/sequence of appearance of the nodes, all can influence 1) where the incision is made, 2) how extensive the dissection is, and 3) how many nodes are removed. In addition, complex patterns can arise from injections. These include prominent lymphatic channels, pseudo-sentinel nodes, echelon and reverse echelon nodes and even contamination, which are much more difficult to access with the probe only. With the detailed information provided by optimized lymphoscintigraphy and triangulated body marking, the surgeon can approach the axilla in a more enlightened fashion, in contrast to when the less informed probe only method is used. This allows for better planning, resulting in the best cosmetic effect and less trauma to the tissues, further reducing morbidity while maintaining adequate sampling of the sentinel node(s).

Journal Article↗
PubMed2003

Psychosocial morbidity associated with patterns of family functioning in palliative care: baseline data from the Family Focused Grief Therapy controlled trial.

Family Focused Grief Therapy (FFGT) is a new model of brief intervention, which is commenced during palliative care for those families shown to be at high risk of poor adaptation, and continued preventively into bereavement with the aim of improving family functioning and reducing the morbid consequences of grief. In this paper, baseline data on 81 families (363 individuals) selected by screening from a palliative care population are explored to confirm our previously reported observation that high levels of psychosocial morbidity are positively associated with worsening family dysfunction. The Family Relationships Index (FRI) was used for screening and the Family Assessment Device (FAD) as an independent family outcome measure. The Beck Depression Inventory (BDI), Brief Symptom Inventory (BSI) and Social Adjustment Scale (SAS) were the psychosocial measures. Families were classified according to their functioning based on the FRI. To allow for correlated family data, statistical analyses employed the generalized estimating equation (GEE) method, controlling for gender and depression (BDI). Screening of 257 families (701 individuals) revealed 74 (29%) well-functioning families and 183 (71%) at some risk of morbid outcome. Of the latter, 81 (44%) gave informed consent to enter a randomized controlled trial of FFGT. Patients had a mean age of 57 years, 51% were male and they suffered from cancer, with a median length of illness from diagnosis to death of 25 months. In accordance with the FFGT model, their family types were identified as Intermediate 51%, Sullen 26% and Hostile 23%. These were significantly associated with steadily increasing levels of distress (BSI) and poor social adjustment (SAS). The FAD confirmed the concurrent accuracy of the FRI. As significantly greater levels of psychosocial morbidity were present in families whose functioning as a group was poorer, support was generated for a clinical approach that screens for families rather than individuals at high risk. The predictive validity of the FRI as a screening measure was confirmed. Overall, these baseline data point to the importance of a family-centred model of care.

Adaptation, Psychological↗
PubMed1980

Socio-economic status and mental morbidity in certain tribes and castes in India--a cross-cultural study.

The authors made a field-survey of mental morbidity in all the tribal and caste groups residing in a cluster of villages in West Bengal, India, and found that, in each group, higher socio-economic classes had higher rates of mental morbidity. Different groups having a similar cultural pattern showed no significant difference in their rates of morbidity. Groups having different cultural patterns differed significantly in their rates of morbidity. In the tribal groups some neurotic disorders were absent.

Cross-Cultural Comparison↗
PubMed1991

Pre-morbid adjustment and personality in psychosis. Effects of sex and diagnosis.

Pre-morbid schizoid and schizotypal traits and social adjustment were assessed blind to diagnosis by interviewing the mothers of 73 consecutively admitted patients with DSM-III schizophrenia or affective psychosis. Analysis of factors associated with pre-morbid deficits showed a highly significant interaction of diagnosis with sex, such that schizophrenic men showed much greater pre-morbid impairment than either schizophrenic women or men with affective disorder. Poor pre-morbid adjustment predicted an early age at first admission. The results can be explained by a neurodevelopmental disorder in some schizophrenic males.

Adolescent↗
PubMed1994

Predictors of psychiatric morbidity in cancer patients.

BACKGROUND: A significant proportion of cancer patients experience psychiatric morbidity in association with diagnosis and treatment. If this morbidity is to be reduced, a better understanding is needed of the factors which influence adjustment to cancer. METHOD: A review of the literature was carried out to explore those factors associated with poor psychological adjustment to cancer. These are described under four heading: characteristics of the patient; disease and treatment variables; the interaction between patient and illness; and environmental factors. RESULTS: A number of risk factors for psychiatric morbidity can be identified from each of the four areas. Methodological limitations are highlighted, in particular the preponderance of cross-sectional study designs. CONCLUSIONS: Increased awareness of the risk factors for psychiatric morbidity should lead to earlier detection and more appropriate treatment. Future research should focus on those risk factors which are potentially modifiable.

Adaptation, Psychological↗
PubMed2006

Maternal psychological morbidity and low birth weight in India.

Depression following childbirth is associated with poor child growth in developing countries. We describe the association between psychological morbidity during pregnancy and low birth weight (<2.5 kg). A cohort of 270 mothers was recruited from a district hospital in Goa, India; all mothers were interviewed with a screening questionnaire for psychological morbidity. Babies of 250 mothers were reviewed at birth to measure their weight. Excluding 5 premature babies, we found that maternal psychological morbidity was independently associated with low birth weight (odds ratio 1.44, 95% CI 1.0-2.07). We conclude that maternal psychological morbidity has an adverse impact on foetal growth.

Adolescent↗
PubMed1989

The classification of psychiatric morbidity in attenders at a dermatology clinic.

Of a random sample of new attenders at a dermatology out-patient clinic, 40% were classified as suffering from a psychiatric disorder. There was no correlation between psychiatric morbidity and the severity or site of skin disease. Self-report measures of the behavioural impact of skin disease and attitudes to appearance were related to psychological morbidity. Except in subjects without visible skin pathology (5%) there was no evidence that psychiatric illness was an aetiological factor in the development of skin disease. Self-report measures were used to distinguish between those patients in whom psychiatric morbidity was closely related to skin disease (75%), and those in whom it may be coincidental (20%). Psychological care for the former group is most appropriately provided by physicians, who should be encouraged to improve their detection and management of psychiatric morbidity.

Adolescent↗
PubMed1999

Pamidronate reduces skeletal morbidity in women with advanced breast cancer and lytic bone lesions: a randomized, placebo-controlled trial. Protocol 18 Aredia Breast Cancer Study Group.

PURPOSE: To assess whether pamidronate can reduce the frequency of skeletal morbidity in women with lytic bone metastases from breast cancer treated with hormone therapy. PATIENTS AND METHODS: Three hundred seventy-two women with breast cancer who had at least one lytic bone lesion and who were receiving hormonal therapy were randomized to receive 90 mg of pamidronate or placebo as a 2-hour intravenous infusion given in double-blind fashion every 4 weeks for 24 cycles. Patients were evaluated for skeletal complications: pathologic fractures, spinal cord compression, irradiation of or surgery on bone, or hypercalcemia. The skeletal morbidity rate (the ratio of the number of skeletal complications to the time on trial) was the primary efficacy variable. Bone pain, use of analgesics, quality of life, performance status, bone tumor response, and biochemical parameters were also evaluated. RESULTS: One hundred eighty-two patients who received pamidronate and 189 who received placebo were assessable. The skeletal morbidity rate was significantly reduced at 12, 18, and 24 cycles in patients treated with 90 mg of pamidronate (P = .028, .023, and .008, respectively). At 24 cycles, the proportion of patients having had any skeletal complication was 56% in the pamidronate group and 67% in the placebo group (P = .027). The time to the first skeletal complication was longer for patients receiving pamidronate than for those given placebo (P = .049). There was no statistical difference in survival or in objective bone response rate. Pamidronate was well tolerated. CONCLUSION: Treatment with 90 mg of pamidronate as a 2-hour intravenous infusion every 4 weeks in addition to hormonal therapy significantly reduces skeletal morbidity from osteolytic metastases.

Adolescent↗
PubMed2004

The nature and course of neuropsychological morbidity in chronic temporal lobe epilepsy.

OBJECTIVE: To characterize the nature and degree of cognitive morbidity in patients with chronic temporal lobe epilepsy compared with healthy control subjects, determine the association between the duration of epilepsy and cognitive morbidity, and ascertain whether there are factors that moderate the association between duration of disorder and cognitive impairment. METHODS: Temporal lobe epilepsy (n = 96) and healthy control (n = 82) subjects were assessed with a comprehensive neuropsychological battery. Test performances were adjusted for age, gender, and education and transformed to a common metric (z scores). Analyses included group comparisons and correlations of duration of epilepsy with cognitive morbidity. RESULTS: Patients with temporal lobe epilepsy exhibited not only worse memory function (p < 0.05) but worse performance across measures of intelligence, language, executive function, and motor speed (p < 0.05). Chronicity of epilepsy was related to worsening mental status (r = 0.42, p < 0.001). This relationship was particularly evident among those individuals with less (r = 0.58, p < 0.001) compared with more (r = 0.25, NS) cerebral reserve, operationally defined by years of formal education. CONCLUSIONS: Neuropsychological morbidity in chronic temporal lobe epilepsy is widespread in nature despite a focal epileptic process. Cross-sectional analyses demonstrate that increasing duration of epilepsy is associated with worsening mental status. Individuals with less educational attainment (low cerebral reserve) exhibit especially poor cognitive function in association with chronicity of epilepsy.

Adolescent↗
PubMed1988

Morbidity and mortality of craniotomy for excision of supratentorial gliomas.

Extensive surgical resection of supratentorial gliomas increases survival. However, some reports suggest that the perioperative morbidity and mortality outweigh the potential benefit of the procedure. We examined prospectively morbidity and mortality in 104 consecutive patients who underwent surgery for supratentorial glioma, as well as other factors that might affect the short-term outcome. To determine if our experience was unusual, we compared these results with those obtained from another academic neurosurgical center by a review of the records of 109 patients also treated surgically for supratentorial glioma. Mortality was 3.3% and the medical plus neurologic morbidity was 31.7%. Functionally significant neurologic worsening occurred in 42 (19.7%) patients. Complications were more frequent in patients with moderate or severe preoperative disabilities than those with mild or no preoperative disability. Patients with complete resection had fewer acute neurologic complications, and no greater risk of being neurologically impaired at 1 week, than patients with biopsy or less extensive procedures. Morbidity and mortality correlated with location: deep-midline lesions had a higher overall rate of perioperative complications (p = 0.032) and mortality (p = 0.019) and bilateral lesions a higher rate of hemorrhage (p = 0.017) and hydrocephalus (p = 0.010). Older patients (greater than 55 years) and those receiving high daily dose of preoperative dexamethasone (greater than or equal to 24 mg) had a significantly higher risk of surgical mortality. Reoperation for recurrent tumor carried no greater risk of mortality, neurologic deterioration, and infection than a first operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Intraoperative brainstem auditory evoked potentials: significant decrease in postoperative morbidity.

Evoked potentials are commonly used for intraoperative monitoring of neural tissue under surgical threat despite the lack of unequivocal evidence demonstrating its effectiveness in preventing neural injury. This study retrospectively compares the auditory morbidity of posterior fossa microvascular decompressive surgery before and after the introduction of intraoperative brainstem auditory evoked potentials (BAEPs). All patients underwent a similar operative procedure performed by a single surgeon. The two groups were comparable with regards to age, sex, and indications for surgery. In the nonmonitored group, auditory morbidity had not declined with increasing experience of the surgeon. Ten of 152 patients (6.6%) suffered a profound hearing loss in the nonmonitored group. In the monitored group, none of 70 patients suffered a profound hearing loss. We attribute this significant decline (p = 0.02) in morbidity to the introduction of intraoperative BAEPs. We believe this to be the first demonstration of a significant decrease in operative morbidity directly associated with the use of intraoperative evoked potential monitoring.

Audiometry↗
PubMed2003

Tumor necrosis factor gene polymorphism is associated with enhanced systemic inflammatory response and increased cardiopulmonary morbidity after cardiac surgery.

UNLABELLED: Cardiopulmonary bypass induces a systemic inflammatory response characterized by alterations in cardiopulmonary function. Mediators for this morbidity are the cytokines tumor necrosis factor (TNF)-alpha and interleukins. A genomic polymorphism within the TNF locus is associated with increased TNF-alpha levels and high mortality in severe trauma and sepsis. We assessed the relationship of biallelic polymorphisms of the TNF locus in patients undergoing elective cardiac surgery to release of proinflammatory cytokines and cardiopulmonary morbidity. TNF genotypes, plasma concentrations of TNF-alpha, interleukin-6, and cardiopulmonary morbidity were studied in 95 unselected, consecutive patients undergoing routine cardiac surgery. TNF genotypes were determined by the solid-phase minisequencing method. Patients homozygous for the TNFB2 allele (n = 42) displayed larger peak concentrations of TNF-alpha (11.3 +/- 1.3 versus 7.8 +/- 0.7 pg/mL; P = 0.013) and interleukin-6 (153 +/- 27 versus 87 +/- 7 pg/mL; P = 0.010) when compared with patients homozygous or heterozygous for TNFB1 (n = 53). The TNFB2 homozygotes had a higher incidence of left ventricular dysfunction (31% versus 9%; P = 0.029; odds ratio 3.84 [95% confidence interval, 1.40-24.3]), postoperative pulmonary dysfunction (24% versus 6%; P = 0.016; odds ratio 5.21 [95% confidence interval, 1.49-18.3]), and a lower pulmonary oxygenation index (29 +/- 1.9 versus 36.1 +/- 1.8; P = 0.013). Patients homozygous for the TNFB2 allele may develop an enhanced systemic inflammatory response with an increased risk of cardiopulmonary morbidity after cardiac surgery. IMPLICATIONS: The associations between tumor necrosis factor (TNF) gene polymorphism, plasma cytokines, and cardiopulmonary function after elective cardiac surgery were evaluated. Patients homozygous for the TNFB2 allele displayed larger concentrations of TNF-alpha and interleukin-6 and had an increased risk of developing left ventricular and pulmonary dysfunction compared with TNFB1 homo- or heterozygotes.

Adult↗
PubMed2005

Morbidity and mortality from surgical treatment of unruptured cerebral aneurysms at Research Institute for Brain and Blood Vessels-Akita.

OBJECTIVE: Although the necessity of craniotomy for an unruptured cerebral aneurysm (UCA) is controversial, surgery is warranted if surgical risks are less than the risks of natural history. In this study, we investigated the need for craniotomy for UCAs on the basis of surgical risk. METHODS: History of cerebrovascular disorders, aneurysm site and size, surgical complications, and clinical outcome were investigated in 368 patients (134 men, 234 women; ages 31-79 yr) who underwent craniotomy for treatment of UCA at our institute between 1993 and 2000. RESULTS: We investigated 549 aneurysms. The mean size was 6.0 mm. Sites affected were the anterior cerebral artery (101 aneurysms), internal carotid artery (224 aneurysms), middle cerebral artery (201 aneurysms), and vertebrobasilar artery (23 aneurysms). The most common previous cerebrovascular disorders were subarachnoid hemorrhage (58 patients, 15.8%) and cerebral infarction (41 patients, 11.1%). Eight patients experienced permanent neurological deficits, for a total morbidity of 2.2%. One patient died, for a total mortality of 0.3%. For UCAs less than 10 mm in size, the morbidity was 0.6% and the mortality was 0%. For UCAs greater than 10 mm in size, the morbidity was 6.1% and the mortality was 1.2%. For UCAs in the anterior cerebral artery or middle cerebral artery, the morbidity was 0.3%. Temporary deficits were more frequently observed in patients older than 70 years of age than in patients 70 years of age or less. CONCLUSION: Surgical treatment is a viable alternative for patients 70 years of age or less with UCAs less than 10 mm in size or UCAs located in the anterior cerebral artery or middle cerebral artery, because the surgical risk of treating such UCAs is sufficiently lower than the annual rupture rate of UCAs (2.3%) and the mental stress suffered by patients with untreated UCAs.

Adult↗
PubMed2003

Intraperitoneal chemohyperthermia using a closed abdominal procedure and cytoreductive surgery for the treatment of peritoneal carcinomatosis: morbidity and mortality analysis of 216 consecutive procedures.

BACKGROUND: Peritoneal carcinomatosis has been regarded as a lethal clinical entity. Recently, aggressive treatments combining intraperitoneal chemohyperthermia (IPCH) with cytoreductive surgery have resulted in long-term survival in selected patients. The aim of this trial was to analyze the mortality and morbidity of 216 consecutive treatments of peritoneal carcinomatosis by IPCH by using a closed abdominal procedure combined with cytoreductive surgery. METHODS: Between February 1989 and August 2001, 207 patients who underwent 216 IPCH procedures using a closed abdominal procedure with mitomycin C, cisplatin, or both were prospectively studied. RESULTS: The postoperative mortality and morbidity rates were 3.2% and 24.5%, respectively. The most frequent complications were digestive fistula (6.5%) and hematological toxicity (4.6%). Morbidity was statistically linked with the carcinomatosis stage (P =.016), the duration of surgery (P =.005), and the number of resections and peritonectomy procedures (P =.042). Duration of surgery and carcinomatosis stage were the most common predictors of morbidity. CONCLUSIONS: The frequency of complications after IPCH and cytoreductive surgery was mainly associated with the carcinomatosis stage and the extent of the surgical procedure. The IPCH closed abdominal procedure has shown an acceptable frequency of adverse events.

Adult↗
PubMed2004

Perioperative morbidity and mortality in elderly gynecological oncological patients (>/= 70 Years) by the American Society of Anesthesiologists physical status classes.

BACKGROUND: We evaluated the morbidity and mortality associated with American Society of Anesthesiologists (ASA) classes III and IV versus ASA classes I and II in elderly women (>/= 70 years) undergoing gynecological oncological surgery. METHODS: From 1986 to 2000, we retrospectively collected patients >/= 70 years of age undergoing oncological gynecological surgery. The study population consisted of 121 ASA class III and IV patients. The control group consisted of the same number of patients with ASA classes I and II, and these were matched to study patients (1:1) by clinical and surgical data. The morbidity and mortality of patients with ASA status III and IV were analyzed before and after 1992. RESULTS: In ASA class III and IV patients, compared with ASA class I and II, a higher rate of severe morbidity (P =.000) occurred, whereas the median postoperative stay was similar (8 days). No differences between patients with ASA class III and IV and ASA class I and II for median operative time, transfusion rate, or median blood loss were found. Mortality was 3% in ASA classes III and IV. CONCLUSIONS: Our study suggests that surgery in elderly gynecological oncological patients aged >/= 70 years with ASA class III or IV results in an acceptable perioperative morbidity and mortality rate.

Aged↗
PubMed2003

A retrospective study of bladder morbidity in patients receiving intracavitary brachytherapy as all or part of their treatment for cervix cancer.

A retrospective study has been undertaken in an attempt to identify physical parameters that could confidently be used to predict an enhanced risk of bladder morbidity following intracavitary brachytherapy. 366 women received brachytherapy as all, or part, of their treatment for cervical cancer at the Christie Hospital in 1990 and 1991, and of these, 60 patients developed identifiable bladder morbidity (graded on a scale of 1-4 using the Franco-Italian glossary). These were age and stage matched with 60 asymptomatic women who were also treated for cervical cancer by brachytherapy during the same time period. The sizes of applicators used in the two groups were noted and compared. The two groups were also compared with respect to the heights of the applicator set above the symphysis pubis, the degree of anteversion or retroversion of the applicator sets and where possible, the doses at the International Commission on Radiation Units and Measurements (ICRU) bladder reference point. Where CT scans of the applications were available, these were reviewed to see if any differences in the size, shape or location of the bladder were apparent. No significant difference was found between the two groups of patients for any of the parameters investigated. The physical factors investigated in this study cannot be used to reliably predict bladder complications. There was a significant correlation between bladder morbidity and morbidity in other pelvic sites.

Adult↗
PubMed1990

Morbidity in pediatric tonsillectomy.

Tonsillectomy is one of the most common operations performed in the pediatric age group. Previous literature on morbidity in tonsillectomy has dealt predominantly with postoperative hemorrhage. Children undergoing tonsillectomy were divided in a prospective and random fashion into eight study groups to evaluate postoperative morbidity as it relates to the surgical technique used (electrocautery, dissection, KTP laser), methods of hemostasis (electrocautery, suture ligature), and the use of postoperative antibiotics. A total of 80 children were evaluated. Using the parameters of morbidity as defined in this study, blunt dissection tonsillectomy using suture ligatures for hemostasis, without postoperative antibiotics was found to result in the least morbidity in the pediatric age group.

Adolescent↗